Cigаrette sales climbed in the U.S. in 2020 for the first time in two decades. Americans bought a total of 203.7 billion cigаrettes last year, up from 202.9 billion the year before, according to a Federal Trade Commission report. The uptick coincided with increased cigаrette promotional and ad spending by tobacco companies.
Smоking is the leading cause of preventable death in the United States, claiming nearly half a million American lives annually, according to the Centers for Disease Control and Prevention. Another 16 million Americans are living with a serious illness caused by smоking.
Though the risks associated with smоking and tobacco use are well established, 42.4 million American adults — or 16.6% of the adult population — regularly smoke cigаrettes. In some parts of the country, however, residents are far more likely to take the dangers associated with smоking seriously.
Using data from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program, 24/7 Tempo identified the 50 U.S. counties with the fewest smokers. Counties and county equivalents are ranked on the adult smоking rate — the share of the 18 and older population who smoke every day or most days and have smoked at least 100 cigаrettes in their lifetime.
Smоking rates in the counties on this list range from 12.5% to 7.1%. The majority of metro areas on this list are located in Western states, including 15 in Utah alone.
Given the proven detrimental effects of smоking, it is perhaps not surprising that some important health outcome measures tend to be better than average in counties with lower smоking rates. For example, in all but a few of the 50 counties with the lowest smоking rates, the share of adults who report being in fair or poor health is below the 16.5% share nationwide.
The correlation between smоking rates and life expectancy is also strong. In nearly every county on this list, average life expectancy at birth is above the national average of 79.2 years.
Click here for the American cities with the fewest smokers
50. Chittenden County, Vermont
> Smoking rate: 12.5%
> Adults reporting poor or fair health: 11.2% — 25th lowest of 3,106 counties
> Premature deaths per 100,000: 249.6 — 189th lowest of 3,081 counties
> Life expectancy at birth (years): 81.76 — 210th highest of 3,073 counties
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49. Broomfield County, Colorado
> Smoking rate: 12.5%
> Adults reporting poor or fair health: 10.0% — 6th lowest of 3,106 counties
> Premature deaths per 100,000: 205.0 — 47th lowest of 3,081 counties
> Life expectancy at birth (years): 82.76 — 98th highest of 3,073 counties
48. Fort Bend County, Texas
> Smoking rate: 12.5%
> Adults reporting poor or fair health: 14.9% — 514th lowest of 3,106 counties
> Premature deaths per 100,000: 218.6 — 81st lowest of 3,081 counties
> Life expectancy at birth (years): 83.02 — 78th highest of 3,073 counties
47. Ventura County, California
> Smoking rate: 12.3%
> Adults reporting poor or fair health: 17.6% — 1,101st lowest of 3,106 counties
> Premature deaths per 100,000: 228.9 — 113th lowest of 3,081 counties
> Life expectancy at birth (years): 82.53 — 123rd highest of 3,073 counties
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46. Middlesex County, Massachusetts
> Smoking rate: 12.3%
> Adults reporting poor or fair health: 11.1% — 23rd lowest of 3,106 counties
> Premature deaths per 100,000: 222.6 — 86th lowest of 3,081 counties
> Life expectancy at birth (years): 82.37 — 140th highest of 3,073 counties
45. Wayne County, Utah
> Smoking rate: 12.3%
> Adults reporting poor or fair health: 15.2% — 567th lowest of 3,106 counties
> Premature deaths per 100,000: 313.7 — 625th lowest of 3,081 counties
> Life expectancy at birth (years): 80.55 — 419th highest of 3,073 counties
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44. Napa County, California
> Smoking rate: 12.3%
> Adults reporting poor or fair health: 15.9% — 711th lowest of 3,106 counties
> Premature deaths per 100,000: 233.3 — 130th lowest of 3,081 counties
> Life expectancy at birth (years): 81.98 — 179th highest of 3,073 counties
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43. Weber County, Utah
> Smoking rate: 12.3%
> Adults reporting poor or fair health: 15.9% — 709th lowest of 3,106 counties
> Premature deaths per 100,000: 334.5 — 839th lowest of 3,081 counties
> Life expectancy at birth (years): 78.48 — 1,138th highest of 3,073 counties
42. Millard County, Utah
> Smoking rate: 12.3%
> Adults reporting poor or fair health: 17.3% — 1,026th lowest of 3,106 counties
> Premature deaths per 100,000: 311.6 — 609th lowest of 3,081 counties
> Life expectancy at birth (years): 81.04 — 320th highest of 3,073 counties
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41. Forsyth County, Georgia
> Smoking rate: 12.2%
> Adults reporting poor or fair health: 12.0% — 62nd lowest of 3,106 counties
> Premature deaths per 100,000: 202.7 — 40th lowest of 3,081 counties
> Life expectancy at birth (years): 82.31 — 145th highest of 3,073 counties
40. Rich County, Utah
> Smoking rate: 12.2%
> Adults reporting poor or fair health: 15.5% — 625th lowest of 3,106 counties
> Premature deaths per 100,000: 321.7 — 689th lowest of 3,081 counties
> Life expectancy at birth (years): 82.76 — 97th highest of 3,073 counties
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39. Alexandria city, Virginia
> Smoking rate: 12.2%
> Adults reporting poor or fair health: 13.1% — 172nd lowest of 3,106 counties
> Premature deaths per 100,000: 191.5 — 27th lowest of 3,081 counties
> Life expectancy at birth (years): 84.12 — 48th highest of 3,073 counties
38. Morris County, New Jersey
> Smoking rate: 12.2%
> Adults reporting poor or fair health: 11.8% — 58th lowest of 3,106 counties
> Premature deaths per 100,000: 212.2 — 59th lowest of 3,081 counties
> Life expectancy at birth (years): 82.62 — 113th highest of 3,073 counties
37. Kane County, Utah
> Smoking rate: 12.1%
> Adults reporting poor or fair health: 15.1% — 542nd lowest of 3,106 counties
> Premature deaths per 100,000: 307.7 — 567th lowest of 3,081 counties
> Life expectancy at birth (years): 79.80 — 635th highest of 3,073 counties
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36. Nassau County, New York
> Smoking rate: 12.1%
> Adults reporting poor or fair health: 12.6% — 117th lowest of 3,106 counties
> Premature deaths per 100,000: 212.5 — 60th lowest of 3,081 counties
> Life expectancy at birth (years): 83.07 — 76th highest of 3,073 counties
35. Pitkin County, Colorado
> Smoking rate: 12.0%
> Adults reporting poor or fair health: 9.8% — 4th lowest of 3,106 counties
> Premature deaths per 100,000: 131.1 — 2nd lowest of 3,081 counties
> Life expectancy at birth (years): 94.40 — 5th highest of 3,073 counties
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34. New York County, New York
> Smoking rate: 11.9%
> Adults reporting poor or fair health: 15.6% — 636th lowest of 3,106 counties
> Premature deaths per 100,000: 210.6 — 55th lowest of 3,081 counties
> Life expectancy at birth (years): 85.27 — 30th highest of 3,073 counties
33. Somerset County, New Jersey
> Smoking rate: 11.9%
> Adults reporting poor or fair health: 12.2% — 75th lowest of 3,106 counties
> Premature deaths per 100,000: 214.6 — 69th lowest of 3,081 counties
> Life expectancy at birth (years): 82.55 — 121st highest of 3,073 counties
32. Williamson County, Texas
> Smoking rate: 11.7%
> Adults reporting poor or fair health: 14.6% — 432nd lowest of 3,106 counties
> Premature deaths per 100,000: 226.2 — 97th lowest of 3,081 counties
> Life expectancy at birth (years): 82.11 — 163rd highest of 3,073 counties
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31. Tooele County, Utah
> Smoking rate: 11.7%
> Adults reporting poor or fair health: 15.8% — 679th lowest of 3,106 counties
> Premature deaths per 100,000: 332.8 — 827th lowest of 3,081 counties
> Life expectancy at birth (years): 78.35 — 1,184th highest of 3,073 counties
30. Placer County, California
> Smoking rate: 11.7%
> Adults reporting poor or fair health: 12.5% — 109th lowest of 3,106 counties
> Premature deaths per 100,000: 226.4 — 98th lowest of 3,081 counties
> Life expectancy at birth (years): 82.40 — 134th highest of 3,073 counties
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29. Fairfield County, Connecticut
> Smoking rate: 11.7%
> Adults reporting poor or fair health: 11.9% — 61st lowest of 3,106 counties
> Premature deaths per 100,000: 216.2 — 72nd lowest of 3,081 counties
> Life expectancy at birth (years): 82.98 — 81st highest of 3,073 counties
28. Fairfax city, Virginia
> Smoking rate: 11.6%
> Adults reporting poor or fair health: 12.8% — 133rd lowest of 3,106 counties
> Premature deaths per 100,000: 345.5 — 972nd lowest of 3,081 counties
> Life expectancy at birth (years): 77.37 — 1,469th lowest of 3,073 counties
27. San Juan County, Washington
> Smoking rate: 11.6%
> Adults reporting poor or fair health: 13.0% — 157th lowest of 3,106 counties
> Premature deaths per 100,000: 169.9 — 15th lowest of 3,081 counties
> Life expectancy at birth (years): 86.17 — 16th highest of 3,073 counties
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26. Box Elder County, Utah
> Smoking rate: 11.5%
> Adults reporting poor or fair health: 16.1% — 737th lowest of 3,106 counties
> Premature deaths per 100,000: 318.1 — 655th lowest of 3,081 counties
> Life expectancy at birth (years): 78.96 — 933rd highest of 3,073 counties
25. Collin County, Texas
> Smoking rate: 11.5%
> Adults reporting poor or fair health: 13.5% — 233rd lowest of 3,106 counties
> Premature deaths per 100,000: 208.5 — 50th lowest of 3,081 counties
> Life expectancy at birth (years): 82.68 — 107th highest of 3,073 counties
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24. Loudoun County, Virginia
> Smoking rate: 11.4%
> Adults reporting poor or fair health: 11.7% — 53rd lowest of 3,106 counties
> Premature deaths per 100,000: 167.7 — 14th lowest of 3,081 counties
> Life expectancy at birth (years): 84.68 — 37th highest of 3,073 counties
23. San Francisco County, California
> Smoking rate: 11.4%
> Adults reporting poor or fair health: 12.6% — 119th lowest of 3,106 counties
> Premature deaths per 100,000: 231.5 — 121st lowest of 3,081 counties
> Life expectancy at birth (years): 84.03 — 50th highest of 3,073 counties
22. Fairfax County, Virginia
> Smoking rate: 11.3%
> Adults reporting poor or fair health: 12.4% — 94th lowest of 3,106 counties
> Premature deaths per 100,000: 165.2 — 12th lowest of 3,081 counties
> Life expectancy at birth (years): 85.63 — 21st highest of 3,073 counties
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21. Contra Costa County, California
> Smoking rate: 11.2%
> Adults reporting poor or fair health: 14.9% — 511th lowest of 3,106 counties
> Premature deaths per 100,000: 231.9 — 123rd lowest of 3,081 counties
> Life expectancy at birth (years): 82.51 — 125th highest of 3,073 counties
20. Salt Lake County, Utah
> Smoking rate: 11.1%
> Adults reporting poor or fair health: 16.4% — 817th lowest of 3,106 counties
> Premature deaths per 100,000: 291.5 — 423rd lowest of 3,081 counties
> Life expectancy at birth (years): 79.76 — 650th highest of 3,073 counties
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19. Alameda County, California
> Smoking rate: 11.1%
> Adults reporting poor or fair health: 15.0% — 519th lowest of 3,106 counties
> Premature deaths per 100,000: 227.8 — 108th lowest of 3,081 counties
> Life expectancy at birth (years): 83.08 — 75th highest of 3,073 counties
18. Washington County, Utah
> Smoking rate: 10.9%
> Adults reporting poor or fair health: 15.9% — 702nd lowest of 3,106 counties
> Premature deaths per 100,000: 265.2 — 258th lowest of 3,081 counties
> Life expectancy at birth (years): 81.96 — 182nd highest of 3,073 counties
17. Orange County, California
> Smoking rate: 10.9%
> Adults reporting poor or fair health: 16.9% — 924th lowest of 3,106 counties
> Premature deaths per 100,000: 211.8 — 57th lowest of 3,081 counties
> Life expectancy at birth (years): 83.21 — 69th highest of 3,073 counties
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16. King County, Washington
> Smoking rate: 10.7%
> Adults reporting poor or fair health: 12.4% — 93rd lowest of 3,106 counties
> Premature deaths per 100,000: 233.6 — 133rd lowest of 3,081 counties
> Life expectancy at birth (years): 82.44 — 129th highest of 3,073 counties
15. Douglas County, Colorado
> Smoking rate: 10.7%
> Adults reporting poor or fair health: 8.6% — the lowest of 3,106 counties
> Premature deaths per 100,000: 162.0 — 10th lowest of 3,081 counties
> Life expectancy at birth (years): 84.02 — 51st highest of 3,073 counties
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14. Cache County, Utah
> Smoking rate: 10.3%
> Adults reporting poor or fair health: 15.0% — 520th lowest of 3,106 counties
> Premature deaths per 100,000: 241.4 — 154th lowest of 3,081 counties
> Life expectancy at birth (years): 81.52 — 244th highest of 3,073 counties
13. San Mateo County, California
> Smoking rate: 10.2%
> Adults reporting poor or fair health: 13.1% — 170th lowest of 3,106 counties
> Premature deaths per 100,000: 175.6 — 17th lowest of 3,081 counties
> Life expectancy at birth (years): 85.04 — 32nd highest of 3,073 counties
12. Arlington County, Virginia
> Smoking rate: 10.1%
> Adults reporting poor or fair health: 11.2% — 28th lowest of 3,106 counties
> Premature deaths per 100,000: 157.9 — 7th lowest of 3,081 counties
> Life expectancy at birth (years): 85.92 — 20th highest of 3,073 counties
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11. Marin County, California
> Smoking rate: 9.9%
> Adults reporting poor or fair health: 11.8% — 55th lowest of 3,106 counties
> Premature deaths per 100,000: 166.8 — 13th lowest of 3,081 counties
> Life expectancy at birth (years): 85.45 — 27th highest of 3,073 counties
10. Los Alamos County, New Mexico
> Smoking rate: 9.6%
> Adults reporting poor or fair health: 9.4% — 3rd lowest of 3,106 counties
> Premature deaths per 100,000: 196.1 — 31st lowest of 3,081 counties
> Life expectancy at birth (years): 83.80 — 55th highest of 3,073 counties
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9. Santa Clara County, California
> Smoking rate: 9.6%
> Adults reporting poor or fair health: 14.3% — 381st lowest of 3,106 counties
> Premature deaths per 100,000: 185.7 — 25th lowest of 3,081 counties
> Life expectancy at birth (years): 84.93 — 33rd highest of 3,073 counties
8. Morgan County, Utah
> Smoking rate: 9.4%
> Adults reporting poor or fair health: 11.0% — 20th lowest of 3,106 counties
> Premature deaths per 100,000: 213.1 — 63rd lowest of 3,081 counties
> Life expectancy at birth (years): 80.63 — 398th highest of 3,073 counties
7. Wasatch County, Utah
> Smoking rate: 9.4%
> Adults reporting poor or fair health: 12.3% — 87th lowest of 3,106 counties
> Premature deaths per 100,000: 183.3 — 23rd lowest of 3,081 counties
> Life expectancy at birth (years): 82.38 — 139th highest of 3,073 counties
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6. Falls Church city, Virginia
> Smoking rate: 9.3%
> Adults reporting poor or fair health: 9.0% — 2nd lowest of 3,106 counties
> Premature deaths per 100,000: 224.9 — 95th lowest of 3,081 counties
> Life expectancy at birth (years): 80.70 — 378th highest of 3,073 counties
5. Montgomery County, Maryland
> Smoking rate: 9.2%
> Adults reporting poor or fair health: 12.3% — 83rd lowest of 3,106 counties
> Premature deaths per 100,000: 190.5 — 26th lowest of 3,081 counties
> Life expectancy at birth (years): 84.60 — 39th highest of 3,073 counties
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4. Howard County, Maryland
> Smoking rate: 9.1%
> Adults reporting poor or fair health: 11.1% — 24th lowest of 3,106 counties
> Premature deaths per 100,000: 197.0 — 32nd lowest of 3,081 counties
> Life expectancy at birth (years): 83.15 — 71st highest of 3,073 counties
3. Davis County, Utah
> Smoking rate: 8.4%
> Adults reporting poor or fair health: 12.4% — 99th lowest of 3,106 counties
> Premature deaths per 100,000: 242.5 — 161st lowest of 3,081 counties
> Life expectancy at birth (years): 80.67 — 388th highest of 3,073 counties
2. Summit County, Utah
> Smoking rate: 8.3%
> Adults reporting poor or fair health: 10.9% — 16th lowest of 3,106 counties
> Premature deaths per 100,000: 150.8 — 6th lowest of 3,081 counties
> Life expectancy at birth (years): 85.07 — 31st highest of 3,073 counties
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1. Utah County, Utah
> Smoking rate: 7.1%
> Adults reporting poor or fair health: 13.2% — 190th lowest of 3,106 counties
> Premature deaths per 100,000: 252.5 — 203rd lowest of 3,081 counties
> Life expectancy at birth (years): 80.63 — 397th highest of 3,073 counties
Methodology
To determine the counties with the fewest smokers, 24/7 Wall St. reviewed the share of adults that are current smokers from the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute joint program’s 2021 County Health Rankings & Roadmaps report. While the CHR report is from 2021, adult smоking rates are from 2018.
Of the 3,220 counties or county equivalents, 3,142 had boundaries that fell within one of the 50 states or the District of Columbia. Counties with a 2019 five-year population estimate from the U.S. Census Bureau of less than 1,000 were excluded.
The remaining 3,106 places were ranked based on the adult smоking rate. Additional information on the share of adults reporting poor or fair health, the number of deaths among residents under age 75 per 100,000, and life expectancy are also from the 2021 CHR.
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